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Risk Perspectives in Telehealth: Licensing

Technology has created opportunities for physicians, dentists, and other healthcare practitioners to extend the reach of their professional practice beyond the physical limitations of their practice settings. Through the use of telehealth technologies, providers can evaluate, diagnose, and treat patients in other localities, which can increase access to, convenience of, and choices in care.

Yet, despite bridging a gap in distance, telehealth does not transcend the boundaries of state laws. Each state has its own statutes and regulations associated with clinical practice and the delivery of healthcare. Because of this, licensing is recognized as a significant barrier for telehealth, and it represents a key area of risk for telehealth providers because of legal and regulatory variations by state. For example, states might:

  • Require full licensure for telehealth practice
  • Offer an abbreviated telehealth licensing process
  • Allow licensed out-of-state providers to provide telehealth services within the state without obtaining a state-specific license (often with limitations)
  • Participate in an interstate compact (i.e., the Nurse Licensure Compact or the Interstate Medical Licensure Compact) that allows providers to have one license that is viable in participating states or sets forth an expedited licensure process in participating states

Because of the complexity associated with telehealth licensing, healthcare providers must be cognizant of the laws and regulations in their states and the states in which their patients are receiving services. Further, the American Society for Healthcare Risk Management notes that “Organizations that provide telemedicine services in multiple states must . . . navigate and meet multiple, potentially disparate requirements.”1

To further complicate matters, some states have specific nuances to their telehealth laws and regulations. For example, some states allow for patients’ homes to serve as originating sites, but only for specific specialties or services, such as mental health therapy. The types of telehealth technology permitted — e.g., live video, store-and-forward imaging, remote patient monitoring, etc. — also can vary by service or specialty across states. Additionally, some states might restrict the types of providers that can be reimbursed for providing telehealth services.2

Another layer of complexity is introduced when healthcare providers and organizations venture into international telehealth services. In these cases, both U.S. laws and the laws of the other country must be understood and implemented as part of the telehealth program. As ECRI explains, “Facilities considering international telemedicine must ensure that their programs comply with both the selected country's regulations and U.S. regulations, as well as global best practices.”3

Although cumbersome and time-consuming, understanding state-specific — and international, if applicable — telehealth laws and regulations, practice acts, and standards of care is vital for healthcare providers and organizations participating in telehealth programs. Failure to do so could have legal and disciplinary implications.

To learn more about laws and regulations in the state(s) in which you practice, visit the Center for Connected Health Policy website, which breaks down current laws and policies for all 50 states and the District of Columbia and provides information about pending legislation and regulations. Additionally, healthcare providers can contact state medical, osteopathic, dental, or nursing boards for information related to telehealth regulations.


1 Russell, D., Boisvert, S., & Borg, J. D. (Eds.). (2018). Telemedicine risk management considerations. The American Society for Healthcare Risk Management. Chicago, IL: ASHRM.

2 Center for Connected Health Policy. (2021). State telehealth laws and Medicaid program policies executive summary: A comprehensive scan of 50 states and D.C. findings & highlights. Retrieved from

3 ECRI. (2022, February 18). Regulatory and liability considerations for telehealth. Health System Risk Management. Retrieved from

This document does not constitute legal or medical advice and should not be construed as rules or establishing a standard of care. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions.

MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and/or regulatory approval and may differ among companies.

 © 2022 MedPro Group Inc. All rights reserved. 


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